Elderly residents in long term care settings, especially in geographically isolated and underserved areas, often fail to receive needed mental health services (MHS). To address this need, a series of studies are proposed to investigate the extent to which a low-cost, readily disseminated form of telecommunications (videoconferencing) can produce diagnostic decisions equivalent to that of traditional, face-to-face interviews (Phase I) and if implemented in practice, can accurately detect depression, cognitive impairment, and movement disorders in long term care facilities (Phase II). During the first two years, comparability studies will test the reliability of videoconferencing to face-to-face interviews. Validity will be measured by having a sample of patients age 60 and older, representing a range of diagnoses (dementia, depression, movement disorders) will be interviewed twice within 24 hours. Interview order will be randomized so that half receive face-to-face prior to videoconferencing and other half receive the reverse. Different psychiatrists blinded to patients' diagnostic information and balanced for interview method will conduct the interviews. Outcomes will include comparability of ratings (GDS, MMSE AIMS) and categorical diagnosis. The phase II study is designed to compare face-to-face psychiatric consultation and videoconferencing for long term care residents. Residents of long term care facilities will be evaluated over 2 years. The sensitivity and specificity of the videoconferencing assessments will be compared to the face-to-face consultations and will be calculated at different levels of symptom severity. Mental Health Service Delivery Options in Long Term Care will answer important questions about the utility of telecommunications in mental health service delivery.